Pelvic floor physical therapy is a treatment approach that uses the principles of physical therapy to provide a structured, effective and safe reconditioning of pelvic floor muscles. The goal of the treatment is to improve the strength and function of pelvic floor muscles and alleviate pain, weakness and dysfunction in the muscles. During the treatment, a skilled physical therapist accesses the muscles through the rectum or vagina and makes manipulations on them to improve their strength and functioning. The therapist may either stretch the muscles if they are short and contracted or apply resistance to improve strength if they weak and dysfunctional.
When is pelvic floor physical therapy recommended?
Pelvic floor therapy is targeted at the pelvic floor muscles, ligaments and connective tissues, all of which work together to support the pelvic organs, contribute to sexual arousal and orgasm, and assist in bladder and bowel control. The tissues are attached to the pelvis, tailbone and sacrum and are coordinated to support the urinary and reproductive tract, including the uterus, prostate, bladder, rectum, urethra, and vagina. They provide pelvic stability and promote proper function of pelvic organs, such as sexual and voiding function, together with posture and breathing. When pelvic muscles fail to work as they should, pain and symptoms that interfere with normal functioning occur.
Pelvic floor physical therapy and orthopedic rehabilitation can help with:
- Urinary incontinence, frequency and urgency
- Painful urination
- Bladder and bowel movements
- Fecal incontinence
- Painful sex or pain in the genital area
- Endometriosis
- Constipation
- Menopause symptoms
- Vaginismus
- Pain in the pelvis, hip, abdomen, thigh, or low back
- Rectal pain
- Unexplained pain
- Endometriosis
- Postpartum and pregnancy wellness
- Interstitial cystitis (IC)
- Pregnancy-related pain
- Testicular pain
Who needs pelvic floor physical therapy?
Pelvic floor physical therapy is recommended as first-line remedy for many disorders of the pelvic region. Both men and women with weakness in pelvic floor muscles can perform exercises to strengthen the floor and enhance bladder and bowel control. Specifically, a physician will refer a patient for the therapy if pelvic floor dysfunction is suspected to have a neuromuscular cause. The dysfunction may result from aging, illness, childbirth, surgery or other conditions and may coexist with other genitourinary problems, such as urinary incontinence, fecal incontinence, bladder-emptying problems, and constipation.
Patients are referred for pelvic floor therapy when they have incontinence, chronic pelvic pain, painful intercourse, and difficulty with bowel movements or urination. Women may see pelvic floor therapists for treatment of endometriosis or vaginismus while men may be treated for premature ejaculation and painful ejaculation. Pelvic floor exercises are beneficial for women with a lower risk of vaginal prolapse, bowel and bladder issues, and those recovering after childbirth. The treatment also helps men who have undergone prostate surgery to have speedy recovery, reduced risk of rectal prolapse and improved bladder and bowel control.
How does pelvic floor physical therapy work?
Pelvic floor therapy begins with history taking, which includes past surgical and medical history, medications, and sexual, gynecologic or obstetric history. A thorough orthopedic examination is performed, with close attention to the lumbar spine and hips, gait and posture. The assessment usually includes evaluation of both internal and external muscles, with patients often asked to stand, walk and sit to enable the therapist to detect any existing posture or joint issues affecting the pelvic floor muscles.
The evaluation helps to determine whether the therapy is appropriate and guides the creation of an appropriate care plan. And usually, the type of therapy recommended depends on the symptoms experienced. For example, relaxing and lengthening muscle exercises may be necessary to relieve some symptoms while in other cases strengthening exercises are appropriate.
So the eventual treatment plan may include:
- Stretching or strengthening exercises of the legs, trunk or pelvic muscles.
- Relaxation exercises for shortened pelvic muscles.
- Education in self-management and prevention.
- Coordination exercises.
- Biofeedback for either relaxation or strengthening of pelvic muscles.
- Modalities such as ice, heat or electrical stimulation.
Through a tailored treatment plan, the physical therapist manipulates pelvic floor muscles to restore their strength and function. For example, shortened and contracted muscles are stretched to relax in order to relieve pelvic floor pain associated with excessive tightening and cramping. Likewise, appropriate techniques are used to strengthen muscles, alleviate contractions associated with overactive bladder, and keep the bladder, rectum and uterus in their positions. Ultimately, the therapy helps to ease pain and associated symptoms, and restore normal functioning.
Which techniques are used in pelvic floor physical therapy?
Most pelvic floor therapy techniques are hands on and include both internal and external treatment. But since internal therapy does not appeal to some people, therapists are usually sensitive to the needs of every individual and do not begin with internal therapy until a patient is ready. External therapy techniques include nerve release, trigger point therapy, deep tissue massage (myofascial release), skin rolling and joint mobilization.
Internal techniques may involve using specialized instruments or passing a finger through rectum or vagina to do trigger point therapy. The therapy is then conducted by applying pressure on a specific point or injecting anesthesia into trigger points—injections are administered by a doctor or nurse practitioner and not a physical therapist. Besides, physical therapy does not always have to be the only treatment. It can be provided together with other forms of pain treatments, such as muscle relaxing medications or Botox injections.
The common techniques used include:
Education
Patients are taught more about their pelvic anatomy and how different elements work alone and together. They also learn how hygiene and habits affect their symptoms.
Pelvic floor exercises
Patients learn to contract and relax pelvic floor muscles relative to other muscles. They also learn breathing and timing techniques that make the exercises more effective. The exercises are designed to stretch tight muscles, strengthen weak muscles and boost flexibility.
Manual therapy
A physical therapist uses hands-on massage and stretching to improve blood circulation, mobility and posture.
Pelvic floor biofeedback
The biofeedback technique helps to observe how the pelvic floor muscles work. A probe is inserted into a man’s rectum or woman’s vagina and results are displayed on a computer screen.
Electrical stimulation
Low voltage electric current is used to teach patients how to coordinate the contractions of their muscles, helping to reduce pain and muscle spasms. A therapist may perform the treatment in the office or provide electrical stimulation unit to be used at home.
Vaginal dilators
Tube-shaped plastic devices are used to help women learn to relax their pelvic muscles for easier penetration. The progressively sized tools are typically inserted into the vagina to help stretch tight tissues. Women who have undergone gynecological cancer treatment usually find vaginal dilators helpful in vaginal rehabilitation after their treatment.
Does pelvic floor physical therapy work?
While pelvic physical therapy sounds unusual and invasive, it is quite effective. Patients see a good success rate and enjoy an improved quality of life after treatment—though efficacy depends on the severity of the condition treated. Treatment of myofascial pelvic pain with the therapy takes 6-8 sessions of one hour each for a few weeks, but may require several months in severe cases. Patients may also need to return for periodic therapy to keep their problems in check.
Are you or your loved one suffering from pelvic pain and associated symptoms? Well, you should know that pelvic pain is not normal at any time and getting early treatment is crucial. The longer you experience chronic pain, the more likely that your nerve receptors will get sensitized to it. As a result, your body will develop a heightened reaction to pain, making it more severe and very difficult to treat. So, if you are experiencing unexplained chronic pelvic pain, consult a specialist in pelvic floor disorders as soon as possible to get timely diagnosis and treatment.
At FYZICAL, pelvic floor therapy is performed by physical therapists with specialized training in internal and external pelvic health dysfunction, examinations and procedures. Our therapists are specially trained in the anatomy and physiology of the lumbo-pelvic region and experienced in identifying and treating dysfunction in the pelvic floor region as well as contributing systems. We endeavor to have a positive effect on all our patients and are proud of the outcomes. For more information on physical therapy and orthopedic rehabilitation for different conditions, visit the FYZICAL website.